Identifying the top 10 research priorities for the school food system in the UK: a priority setting exercise

Introduction The school food system varies widely between schools and across the UK. There is a need to understand evidence gaps in school food research to allow the development, implementation and evaluation of policies and interventions to support children’s healthy eating at school. This study aimed to conduct a priority setting exercise to co-produce research priorities in relation to the UK school food system. Methods The James Lind Alliance process informed this priority setting exercise; all key steps engaged a wide range of UK school food stakeholders (including teachers, parents, principals, school governors, policymakers, caterers). An initial online stakeholder survey identified perceived research priorities. In a second survey, stakeholders were asked to rank these priorities. Lastly, an online priority setting workshop with stakeholders elicited the most important research priorities. Results In 2021, school food stakeholders (n=1280) completed the first survey, from which 136 research priorities were identified. In the second survey, participants (n=107) ranked these research priorities regarding their importance. Lastly, 30 workshop participants discussed and reached consensus on the research priorities. After final refinement by the research team, 18 priorities resulted, with the top 10 being related to the provision of free school meals (effectiveness of cost-effectiveness of different levels of eligibility, including universal provision), implementation of policy (including improving uptake) and food standards, issues around procurement, leadership, inequalities, social norms, the eating environment, food culture throughout the school setting and healthy eating. Conclusion The top 10 research priorities were elicited through a rigorous approach, including a wide range of stakeholders across the UK. These should be considered by policymakers, researchers and others to inform research, evidence-based policy development and, ultimately, improve the UK school food system.

Background -This is clear and succinct.
Methods -Quite complex to explain, but clearly justified and transparent overall.
Ethical approval and the PPI aspect was flagged in different parts of the paper.Eg P9 Lines 181-883 and P14 Line 303 and elsewhere.I appreciate that the effort was to be accountable about the ethical aspects at each stage, however the references were a bit repetitive and might have been condensed into one summary.Results.Overall, these are clearly set out.The table of priorities appear well framed and useful, which is a good indicator of the quality of the processes underpinning the outcomes of the study.Discussion.A good account overall of the novelty of the study in relation to other work.Some discussion of the limitations.Were other recruitment options assessed, for instance a quota sampling approach for Survey 1? I am not convinced it was a good decision to include both primary and secondary schools within the frame of the study.It added to the complexity to the task of obtaining representative voices.The pronounced differences in issues between these settings makes it much harder to arrive well research questions.Overall, the broad perspective appears to have muddied the picture and reduced the usefulness of the results.However, I accept that this is a research choice and some rationale is given.
I was curious to see that food education did not clearly feature appear in the final priorities.Is there anything the authors can report about this?Did it feature, but fail to reach the final 18? Could it have been side lined given attention to food provisioning questions?Is it implicit within some priorities (#7, #9)?Overall, the absence is noteworthy given its clear position as one aspect of the school food system and prominence in current agendas (see Dimbleby H. National Food Strategy: Independent Review.2021).

Conclusion. This is clear and succinct.
Presentation -Good overall.See typos: P6 Line 93 surplus apostrophe after Genius network P19 Table 'Parent/carer'capital for Carer for consistency

REVIEWER
Vine, Michelle M. Brock University, Health Sciences REVIEW RETURNED 16-Nov-2023

GENERAL COMMENTS
Excellent paper.I appreciated the opportunity to review it, and have included minor revisions for the authors.1.This paper requires an editorial review for grammar and punctuation.
2. I would recommend adding in some next steps at the end of the paper.The results are clear and concise, and flow directly from the priority setting exercise.It would be nice to see how the priorities could be implemented through next steps in research and evaluation.

VERSION 1 -AUTHOR RESPONSE
Reviewer:1 Comments to the Author: • Title -This is clear and a fair description of the study • Abstract -Clear overall.I would have preferred more attention to summarising the 10 research priorities.These are results that will interest audiences, possibly more so than the execution of the JLA process.
Author response: The abstract has been modified as suggested, although it is challenging given overall word limits.
• Background -This is clear and succinct.
• Methods -Quite complex to explain, but clearly justified and transparent overall.
• Ethical approval and the PPI aspect was flagged in different parts of the paper.Eg P9 Lines 181-883 and P14 Line 303 and elsewhere.I appreciate that the effort was to be accountable about the ethical aspects at each stage, however the references were a bit repetitive and might have been condensed into one summary.
Author response: We have kept the declarations separate but have merged the various sections where Ethics and PPI were mentioned and placed them at the end of the various stage descriptions as requested for clarity.
• Results.Overall, these are clearly set out.The table of priorities appear well framed and useful, which is a good indicator of the quality of the processes underpinning the outcomes of the study.
• Discussion.A good account overall of the novelty of the study in relation to other work.
• Some discussion of the limitations.Were other recruitment options assessed, for instance a quota sampling approach for Survey 1?
Author response: This limitation and an explanation of it has been (see lines 304-308) • I am not convinced it was a good decision to include both primary and secondary schools within the frame of the study.It added to the complexity to the task of obtaining representative voices.The pronounced differences in issues between these settings makes it much harder to arrive well framed research questions.Overall, the broad perspective appears to have muddied the picture and reduced the usefulness of the results.However, I accept that this is a research choice and some rationale is given.
Author response: This limitation and an explanation of it has been added (although we believe that the broad perspective, as well as being pragmatic, can also be seen as a strength); see lines 304-308 • I was curious to see that food education did not clearly feature appear in the final priorities.Is there anything the authors can report about this?Did it feature, but fail to reach the final 18? Could it have been side lined given attention to food provisioning questions?Is it implicit within some priorities (#7, #9)?Overall, the absence is noteworthy given its clear position as one aspect of the school food system and prominence in current agendas (see Dimbleby H. National Food Strategy: Independent Review.2021).
Author response: Food education was considered within priority 7, and this is now described within the discussionbut it certainly did not feature at any stage as strongly as the food provision questions (line 276-279).
• Conclusion.This is clear and succinct.
• Presentation -Good overall.See typos: P6 Line 93 surplus apostrophe after Genius network P19 Table 'Parent/carer'capital for Carer for consistency Author response: These changes have been completed.
• Competing interests of Reviewer: None Reviewer: 2 Comments to the Author: • Excellent paper.I appreciated the opportunity to review it, and have included minor revisions for the authors.
• This paper requires an editorial review for grammar and punctuation.
Author response: This has been completed.
• I would recommend adding some next steps at the end of the paper.The results are clear and concise, and flow directly from the priority setting exercise.It would be nice to see how the priorities could be implemented through next steps in research and evaluation.
Author response: We believe this exists to some extent in lines 286-296, but we have added some extra detail to this section; we have also added some further ideas around future steps in response to reviewer 1 e.g.lines 314-317.

GENERAL COMMENTS
Excellent job on the revisions of this paper.I would strongly suggest another read through for grammar and punctuation.
I look forward to seeing this paper in print!
• Competing interests of Reviewer: No competing interests.